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Case 2

As part of Spot's annual visit, you will run a CBC and serum chemistry panel, but given his hepatomegaly and difficulty rising, you also recommend abdominal and pelvic radiographs. The owner declines since she thinks Spot is doing fine and wants to wait and see what the blood tests show.

Laboratory results
These are the notable findings from your CBC and serum chemistry profile.

CBC with differential
All results normal

Serum chemistry panel

Patient values

Reference range

ALT (IU/L)

46

12-118

ALP (IU/L)

526

5-131

Bilirubin (mg/dl)

0.1

0.1-0.3

Albumin (g/dl)

3.2

2.7-4.4

Globulin (g/dl)

2.9

1.6-3.6

Glucose (mg/dl)

92

70-138

Cholesterol (mg/dl)

216

92-324

T4 (µg/dl)

1.2

1-4

QUESTION 1
What would be a reasonable next step in working up the elevated alkaline phosphatase (ALP) activity in this patient? (There is more than one correct answer.)